The development of a home-based technology to improve gait in people with Parkinson's disease: a feasibility study.

BACKGROUND: People with Parkinson's disease (PwP) may experience gait impairment and freezing of gait (FOG), a major cause of falls. External cueing, including visual (e.g., spaced lines on the floor) and auditory (e.g., rhythmic metronome beats) stimuli, are considered effective in alleviating mobility deficits and FOG. Currently, there is a need for a technology that delivers automatic, individually adjusted cues in the homes of PwP. The aims of this feasibility study were to describe the first step toward the development of a home-based technology that delivers external cues, test its effect on gait, and assess user experience. METHODS: Iterative system development was performed by our multidisciplinary team. The system was designed to deliver visual and auditory cues: light stripes projected on the floor and metronome beats, separately. Initial testing was performed using the feedback of five healthy elderly individuals on the cues' clarity (clear visibility of the light stripes and the sound of metronome beats) and discomfort experienced. A pilot study was subsequently conducted in the homes of 15 PwP with daily FOG. We measured participants' walking under three conditions: baseline (with no cues), walking with light stripes, and walking to metronome beats. Outcome measures included step length and step time. User experience was also captured in semi-structured interviews. RESULTS: Repeated-measures ANOVA of gait assessment in PwP revealed that light stripes significantly improved step length (p = 0.009) and step time (p = 0.019) of PwP. No significant changes were measured in the metronome condition. PwP reported that both cueing modalities improved their gait, confidence, and stability. Most PwP did not report any discomfort in either modality and expressed a desire to have such a technology in their homes. The metronome was preferred by the majority of participants. CONCLUSIONS: This feasibility study demonstrated the usability and potential effect of a novel cueing technology on gait, and represents an important first step toward the development of a technology aimed to prevent FOG by delivering individually adjusted cues automatically. A further full-scale study is needed. Trial registration This study was registered in ClinicalTrials.gov at 1/2/2022 NCT05211687.

Engagement of medication users in the development and implementation of digital medication adherence technologies: a multi-stakeholder study.

BACKGROUND: This study aims to create a comprehensive framework for the development and implementation of digital medication adherence technologies (DMATech), focusing on critical stages where engagement of medication users (MU) is considered meaningful, i.e. adds significant value, as agreed upon by participating stakeholders. METHODS: Through a literature review and expert consensus, a framework was outlined covering key DMATech development and implementation phases and steps. An in-person workshop with MU representatives and adherence experts, using the Nominal Group Technique, further refined these stages for MU engagement. RESULTS: The DMATech framework included three phases: 'Innovation,' 'Research and Development,' and 'Launch and Implementation,' each encompassing multiple steps. The workshop, attended by five MU representatives and nine adherence experts, identified critical stages for MU input including context analysis, ideation, proof of concept, prototype creation, DMATech's iteration, critical evaluation, healthcare implementation, real-world assessment, and improvement. Nevertheless, there was a divergence of consensus regarding the importance of MUs engagement in regulatory, financial, and marketing aspects. CONCLUSIONS: This study provides a holistic framework for DMATech development and implementation and underscores the necessity of MU engagement at various stages. Modes of MU engagement cannot be generalized; a case-by-case evaluation of engagement strategies is essential.

European Network to Advance Best Practices and Technology on Medication Adherence: Mission Statement.

Medication non-adherence is associated with almost 200,000 deaths annually and €80-125 billion in the European Union. Novel technological advances (smart pill bottles, digital inhalers and spacers, electronic pill blisters, e-injection pens, e-Health applications, big data) could help managing non-adherence. Healthcare professionals seem however inadequately informed about non-adherence, availability of technological solutions in daily practice is limited, and collaborative efforts to push forward their implementation are scarce. The European Network to Advance Best practices and technoLogy on medication adherencE (ENABLE, COST Action 19132) aims to 1) raise awareness of adherence enhancing solutions, 2) foster knowledge on medication adherence, 3) accelerate clinical application of novel technologies and 4) work collaboratively towards economically viable policy, and implementation of adherence enhancing technology across healthcare systems.

Evaluation of data display for patient-oriented electronic record of anticoagulant therapy.

OBJECTIVE: Our aim was to evaluate visualization methods for specific tasks performed with personal healthcare e-record systems for lay adults and older patients. We investigated common visualization methods for data entry and follow-up of personal and clinical information for self-control of blood coagulation functions. METHODS: Twenty-five old (72.2 +/- 5.5 years) and 25 young (30.4 +/- 4.9 years) participants completed tasks based on common scenarios, on experimental Web sites with hidden tracking programs. Functional parameters (time, accuracy), subjective parameters (preference, satisfaction), and physiological parameters (heart rate, skin temperature, sweat, respiratory rate, and muscle tension) monitored with miniature sensors were used. RESULTS: Total time for data entry and information follow-up were significantly longer for older compared with younger participants, with no significant differences in accuracy (errors), in stress-related physiological parameters, in preferences, or in satisfaction between age group. The Menu display was the significantly preferred configuration for data entry in both age groups, based on functional, physiological, and subjective criteria (p < 0.05, Duncan test). The Calendar configuration was significantly preferred for mixed tasks of follow-up and information retrieval, in both age groups, based on functional, physiological, and subjective criteria (p < 0.05, Duncan test). CONCLUSIONS: Our study supports equal capabilities of old and young people to use interactive healthcare systems for management of chronic diseases and further encourages using physiological, functional, and subjective methods for evaluating personal healthcare records.

Portable Health Care Facilities in Disaster and Rescue Zones: Characteristics and Future Suggestions.

IntroductionNatural and man-made disasters are becoming global concerns. Natural disasters appear to be growing in number and intensity due to global warming, population explosion, increased travel, and overcrowding of cities. In addition, man-made disasters do not seem to be diminishing.At disaster sites, an immediate response is needed. National and international organizations; nongovernmental, military, and commercial organizations; and even private donors enlist to provide humanitarian and medical support and to send supplies, shelters, and temporary health care facilities to disaster zones.ProblemThe literature is sparse regarding the design of portable health care facilities intended for disaster zones and their adaptability to the tasks required and site areas. METHODS: Data were collected from peer-reviewed literature, scientific reports, magazines, and websites regarding health care facilities at rescue and salvage situations. Information was grouped according to categories of structure and properties, and relative strengths and weaknesses. Next, suggestions were made for future directions. RESULTS: Permanent structures and temporary constructed facilities were the two primary categories of health care facilities functioning at disaster zones. Permanent hospitals were independent functioning medical units that were moved or transported to and from disaster zones as complete units, as needed. These facilities included floating hospitals, flying (airborne) hospitals, or terrestrial mobile facilities. Thus, these hospitals self-powered and contained mobility aids within their structure using water, air, or land as transporting media.Temporary health care facilities were transported to disaster zones as separate, nonfunctioning elements that were constructed or assembled on site and were subsequently taken apart. These facilities included the classical soft-type tents and solid containers that were organized later as hospitals in camp configurations. The strengths and weaknesses of the diverse hospital options are discussed. CONCLUSIONS: Future directions include the use of innovative materials, advanced working methods, and integrated transportation systems. In addition, a holistic approach should be developed to improve the performance, accessibility, time required to function, sustainability, flexibility, and modularity of portable health care facilities.Bitterman N, Zimmer Y. Portable health care facilities in disaster and rescue zones: characteristics and future suggestions. Prehosp Disaster Med. 2018;33(4):411-417.

Hypoxia-reoxygenation contributes to increased frequency of venous thromboembolism in air travellers.

Commercial air travel is widespread, with close to 2 billion people traveling each year. The association between venous thromboembolism (VTE) and confined sitting has been established and a correlation between the distance traveled and its incidence had been documented. Most studies underscore stasis caused by immobility as the cause of VTE and ignore the possible contribution of additional factors including coagulation and the blood vessel wall. Recent studies indicate that hypobaric hypoxia may contribute to blood vessel wall alteration and activation of coagulation. We suggest that air travel associated hypobaric hypoxia may lead to endothelial injury and initiation of a pro-coagulatory response, effects which are augmented by the reoxygenation upon landing, thus culminating in thrombosis. Prevention of air travel associated hypoxia and reoxygenation injury may decrease the incidence of flight associated VTE.

Design and Human Factors of Therapeutic Hyperbaric Chambers.

INTRODUCTION: Hyperbaric therapeutic chambers are pressure vessels capable of accommodating one or more persons with the purpose of providing medical treatment. Therapeutic hyperbaric chambers have been in use from the mid-20(th) century, yet apparently their design has not reached their full potential and they are not compatible with current healthcare facilities design. This paper will present therapeutic hyperbaric chambers from a human-environment-machine perspective in order to highlight their specific problems and requirements, and suggest design concepts that may improve patient satisfaction, quality of treatment, and functionality of the staff. Data were collected from a literature review, a market survey, and personal observations. Main design solutions include personal space and privacy, stress- and anxiety-reducing environments, hazard mitigation, rearrangement of seating, and personalized (user-tailored) entertainment systems. It is suggested that adopting a user-centered design rather than an engineering focus will increase satisfaction and overall 'user experience' of the patients, alleviate psychological issues, and lessen workload and improve functionality of the staff. This study could be applicable and easily adapted to other confined therapeutic environments in which patients are restrained for several hours on a regular basis in receiving treatment, such as dialysis or chemotherapy rooms, and for confined nonmedical situations such as aircrafts and rapid trains.

Profile of graduates of Israeli medical schools in 1981--2000: educational background, demography and evaluation of medical education programs.

BACKGROUND: In light of changes in the medical profession, the different requirements placed on physicians and the evolving needs of the healthcare system, the need arose to examine the medical education curriculum in Israel. This survey, conducted by the Samuel Neaman Institute for Science and Technology, summarizes 20 years of medical education in Israel's four medical schools, as the first stage in mapping the existing state of medical education in Israel and providing a basis for decision-making on future medical education programs. OBJECTIVES: To characterize the academic background of graduates, evaluate their attitudes towards current and alternative medical education programs, and examine subgroups among graduates according to gender, medical school, high school education, etc. METHODS: The survey included graduates from all four Israeli medical schools who graduated between the years 1981 and 2000 in a sample of 1:3. A questionnaire and stamped return envelope were sent to every third graduate; the questionnaire included open and quantitative questions graded on a scale of 1 to 5. The data were processed for the entire graduate population and further analyzed according to subgroups such as medical schools, gender, high school education, etc. RESULTS: The response rate was 41.3%. The survey provided a demographic profile of graduates over a 20 year period, their previous educational and academic background, additional academic degrees achieved, satisfaction, and suggestions for future medical education programs. CONCLUSIONS: The profile of the medical graduates in Israel is mostly homogenous in terms of demographics, with small differences among the four medical schools. In line with recommendations of the graduates, and as an expression of the changing requirements in the healthcare system and the medical profession, the medical schools should consider alternative medical education programs such as a bachelor's degree in life sciences followed by MD studies, or education programs that combine medicine with disciplines such as law, engineering, computer science, among others.

Design of medical devices--a home perspective.

Health care services are moving out to the community and into the home; e-health services, remote monitoring technology and self-management are replacing hospitalization and visits to medical clinics and custom-tailored medicines are making inroads into normative treatment. These developments have great implications for the scope and design of home health care equipment. The paper discusses the unique nature of home medical devices, from a human-environment-machine perspective, focusing on the nature of users, environment and tasks performed. We call for increased awareness and active continuous involvement of health care personnel together with bioengineers, human factors experts, architects, designers and end users--patients and caregivers--in defining the objectives of health care devices and services at home in terms of "all family" use, integrated into the overall surroundings ("smart home"), and as part of a collaborative patient-physician disease management team.

Technologies and solutions for data display in the operating room.

Recent advances in technology have led to the introduction of a variety of innovative devices, each with their own platform for data display, into the operating room (OR). While these innovative applications are expanding the traditional boundaries of the surgical space and enhancing treatment capabilities, the introduction of additional screens and displays is placing an ever-increasing load on the OR team. This review describes the main data display platforms currently available in ORs: computer monitors with CRT (cathode ray tube) or LCD (liquid crystal display) screens, suspended imaging displays, wearable computers (WC), auditory displays and tactile (haptic) displays. The different display platforms are evaluated according to their compatibility with the characteristics of the working environment (OR), the monitoring task, and the users (the surgical team). No single display configuration provides an ultimate solution for presenting patient data in the OR. A multi-sensory data display including visual, acoustic and haptic manipulation is suggested as a promising configuration for data display in the OR.

Exploring methods of visualizing laboratorial data in electronic medical record systems.

Physicians in their daily practice are exposed to vast amount of laboratorial data in electronic medical record (EMR) systems, that should be taken into account in the clinical decision making process. The aim of this study is to explore the impact of different methods of visualizing laboratorial data on physicians' ability to perform common tasks related to processing laboratorial data. For this end, we developed an innovative computerized system based on a set of methods that we used.